应用OCTA评估白内障患者超声乳化吸除术后视网膜厚度及血流密度的变化

Evaluation of the Changes about Retinal Thickness and Vessel Density after Phacoemulsification in Cataract Patients by OCTA

目的:应用光学相干断层扫描血流成像技术(OCTA)血流量化标准2.0研究白内障患者术前眼轴与视网膜厚度及血流密度的关系,及白内障超声乳化吸除术后视网膜厚度、血流密度的变化情况。方法:回顾性研究。连续性纳入2021年1—7月在宁波爱尔光明眼科医院诊断为年龄相关性白内障并接受白内障超声乳化吸除术的患者25例(38眼),并收集OCTA在术前,术后1d、1周、1个月、3个月测量的黄斑区内层、全层视网膜厚度以及视盘周围神经纤维层厚度(RNFL)的资料,观察黄斑区和视盘区深、浅层血流密度及视网膜厚度变化情况。应用单因素重复测量方差分析对数据进行统计分析。结果:术后3个月黄斑厚度与术前相比呈上升趋势,术前黄斑厚度为278.00(261.50,285.00)μm,术后1 d、1周、1个月、3个月分别为277.00(257.00,283.25)、279.00(257.00,286.50)、285.50(268.25,294.50)、285.00(270.50,297.25)μm(χ^(2)=83.83,P<0.001);黄斑上方、下方、中心凹、中心凹旁及中心凹周围的厚度均呈现同样的增加趋势(均P<0.001)。黄斑浅层血流密度术后呈增加趋势,术前为45.40%(42.40%,47.40%),术后1 d、1周、1个月、3个月分别为44.10%(40.70%,46.30%)、45.20%(42.00%,48.20%)、46.60%(42.90%,50.20%)、47.25%(44.50%,50.10%)(χ^(2)=16.73,P=0.002);黄斑部上方、下方、中心凹、中心凹旁及中心凹周围的浅层血流密度术后均较术前增加(均P<0.05);黄斑深层血流密度术后也呈增加趋势,但差异无统计学意义(P>0.05)。术后3个月,视盘区RNFL较术前增加,术前为111.00(91.00,114.00)μm,术后1 d、1周、1个月、3个月分别为110.00(89.00,114.00)、110.00(89.00,115.00)、116.00(92.00,123.00)、113.50(94.00,123.00)μm(χ^(2)=58.30,P<0.001)。视盘血流密度、视盘内血流密度术后3个月较术前增加,但差异均无统计学意义(均P>0.05),视盘周围血流密度术后3个月较术前略降低,差异无统计学意义(P>0.05)。Spearman相关分析显示,白内障患者术前眼轴与黄斑厚度、视盘RNFL及视盘血流密度均呈负相关(r=-0.47,P=0.003;r=-0.38,P=0.018;r=-0.49,P=0.002)。结论:黄斑区和视盘区视网膜厚度、血流密度在白内障术后均呈现增加趋势,且术前眼轴与黄斑厚度、视盘RNFL厚度、视盘血流密度呈负相关。

Objective:To determine the relationship between axial length,retinal thickness,and vessel density in cataract patients before operation,and explore the changes of retinal thickness and vessel density after cataract surgery using OCTA quantification standard 2.0.Methods:This was a retrospective study.Patients diagnosed with age-related cataract and underwent phacoemulsification in our hospital from January to July 2021 were collected.The thickness of retinal and vessel density in macula and optic disc were measured by OCTA before operation,1 day after operation,1 week after operation,1 month after operation,and 3 months after operation.The single factor repeated measure ANOVA was used for statistical analysis.Results:Three months after operation,the macular thickness showed an upward trend,with 278.00(261.50,285.00)μm before operation,277.00(257.00,283.25)μm 1 day after operation,279.00(257.00,286.50)μm 1 week after operation,285.50(268.25,294.50)μm 1 month after operation,285.00(270.50,297.25)μm 3 months after operation(2=83.83,P<0.001).The thickness of superior and inferior macula,fovea,parafovea,and perifovea showed a similar trend of increase(all P<0.001).The superficial macular vessel density showed an increasing trend after operation,45.40%(42.40%,47.40%)before operation,44.10%(40.70%,46.30%)1 day after operation,45.20%(42.00%,48.20%)1 week after operation,46.60%(42.90%,50.20%)1 month after operation,47.25%(44.50%,50.10%)3 months after operation(2=16.73,P=0.002).The superficial vessel density above and below the macula,fovea,adjacent to the fovea and around the fovea increased after operation compared with that before operation(all P<0.05).After phacoemulsification,deep macular vessel density was similar to macular thickness and superficial macular blood flow,but there was no statistical significance(P>0.05).The thickness of RNFL increased 3 months after operation,111.00(91.00,114.00)μm before operation,110.00(89.00,114.00)μm 1 day after operation,110.00(89.00,115.00)μm 1 week after operation,116.00(92.00,123.00)μm 1 month after operation,113.50(94.00,123.00)μm at 3 months after operation(2=58.30,P<0.001).The optic disc vessel density and intra optic disc vessel density at 3 months after operation were increased compared with those before operation,but there was no statistical significance(P>0.05).The perioptic disc blood flow at 3 months after operation was slightly decreased compared with that before operation(P>0.05).Spearman correlation analysis showed that the axial length before operation was negatively correlated with macular thickness,optic disc retinal nerve fiber layer(RNFL),and optic disc blood flow(r=-0.47,P=0.003;r=-0.38,P=0.018;r=-0.49,P=0.002,respectively).Conclusions:Retinal thickness and vessel density in macular area and optic disc area showed an increasing trend after cataract surgery,and the axial length of the eye before operation was negatively correlated with macular thickness,optic disc RNFL thickness and optic disc vessel density.